Details Participants
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n FE n TRE n CRE n IRE n SFE n FIE n RFE n RFIE
n Senior
n A n H n As n Pl n S n B
Details Event
n Initial issue n Revalidation n Renewal n Skill test n FCL check
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Evaluation of applicant/examiner
+ - n/a
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A. Applicant/examiner meets requirements n n|
B. Briefing|
1. Checking ID and requirements crewmembers □ □ n n n□|
2. Conduct of briefing □ □ n n n|
3. Indicating aim/importance of session □ □ n n n|
4. Checking of theoretical knowledge □ □ n n n1
1.1 Name / license number applicant 1.2 Name / license number
Inspector/senior examiner 1.3 Names / license numbers flight
crew members
1.4 Holder of / applicant for
1.5 Category
2
2.1 Assessment of competence 2.2 Event during AoC 2.3 Date and location of AoC 2.4 Aircraft type and registration
or Simulator type and FSTD number
3
3.1 Assessment
Report
Examiner assessment of competence
For FE/TRE/CRE/IRE/SFE/FIE and RFE/RFIE (national use only)
This form shall be used by an inspector or senior-examiner to report the result of an examiner assessment of competence (AoC).
If the applicant meets all requirements CAA-NL will issue an new certificate after receipt of this report form.
Incomplete or incorrectly filled out forms (including absence of additional documents) will not be processed.
Send the form to iltdocumentmanagement@ilent.nl or send to Inspectie Leefomgeving en Transport / Luchtvaart P.O. Box 16191, 2500 BD Den Haag
Additional information 088 489 00 00 | www.ilent.nl
ILT.219.04 | 1 of 3
+ - n/a
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C. Session|
1. Safety aspects □ □ □ n n n|
2. Relevant/compliant i.a.w P. art-FCL, Part-BFCL or Part SFCL n n n|
3. Conduct of practical part □ □ n n n|
4. Handling of simulator/aircraft □ □ n n n|
5. Handling of simulator/aircraft problems □ □ n n n|
6. Simulating role as ATC, purser etc. □ □ n n n|
D. Debriefing|
1. Conduct of debriefing □ □ n n n|
2. Crew assessment/grading □ □ n n n|
E. Knowledge of|
1. Examination documents / administration □ □ □ n n n|
2. Certificates / licenses / prerequisites and requirements □ n n n|
F. General|
1. Appearance / behavior □ □ n n n|
2. Attitude □ □ n n n>
(See AMC1 FCL.1020, AMC1 BFCL.445 or AMC1 SFCL.415 for information about the content and general conduct of AoC's)Results
| n A n B n C n D n E n F
n Passed n Failed
Remarks
Subscribing
I declare that that all required information has been provided completely and truthfully
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4
4.1 Evaluation results (+ or -) (To pass all results have to be a '+') 4.2 Result
5
5.1 Your remarks
6
6.1 Signature applicant/examiner
6.2 Signature inspector or senior examiner
Report
Examiner assessment of competence Human Environment and Transport Inspectorate Ministry of Infrastructure and Water ManagementILT.219.04 | 2 of 3
7 Reference items
A1 Applicant/examiner requirements A1.1 Identification of applicant/examiner A1.2 Part FCL subpart K requirements A1.3 Training completed
B1 Checking ID and requirements B1.1 Checking ID of flight crew members B1.2 Checking requirements for test/check B2 Conduct of briefing
B2.1 Presentation & discussion of subjects B2.2 Structuring & planning of time B3 Indicating aim, importance of session B3.1 Explaining due date & revalidation B3.2 Explaining possible consequences of failing B3.3 Explaining consequences of wrong information B4 Checking of theoretical knowledge
B4.1 Checks knowledge according requirements B4.2 Uses correct questioning technique B4.3 Clarifies doubtful answers by asking C1 Safety aspects
C1.1 Has knowledge of applicable safety aspects C1.2 Checks/explains safety aspects
C1.3 Takes responsibility for safety C2 Relevant/compliant i.a.w. Part-FCL C2.1 Approved program used, if available C2.2 Program i.a.w. flight test schedule C2.3 Program adapted when necessary
C2.4 In accordance with standardization requirements C3 Conduct of practical part
C3.1 On time starting & finishing C3.2 Sticking to program’s timeframe C3.3 Effective use of time and breaks C3.4 Following the program subjects C3.5 Influencing the session
C3.6 Observing candidates performance C4 Handling of simulator/aircraft C4.1 Operation of simulator
C4.2 Dealing with security / safety regulations C5 Handling of simulator/aircraft problems C5.1 Dealing with effects of problems & program C5.2 Handling / registration of complaints
C6 Simulating role as ATC, Purser etc.
C6.1 Using correct RT C6.2 Acting conform reality D1 Conduct of debriefing
D1.1 Presentation & discussion of observations D1.2 Structuring & planning of time
D1.3 Using examples
D1.4 Flexibility in debriefing skills
D1.5 Dealing with candidate’s questions & remarks D2 Crew assessment/grading
D2.1 Assessment i.a.w. part-FCL guidelines D2.2 Debriefing according assessment D2.3 Report according debriefing
E1 Examination documents / administration E1.1 Skill test report form
E1.2 Flight test schedule E1.3 Part-FCL
E1.4 Cross crediting E1.5 Operator forms
E2 Certificates / licenses / prerequisites and requirements E2.1 Pilots licenses
E2.2 Instructor/examiner certificates E2.3 Ratings and endorsements
E2.4 Revalidation / renewal procedures and requirements E2.5 Examination Regulations
F1 Appearance / behaviour F1.1 Language / dress
F1.2 Exemplary role as examiner
F1.3 Atmosphere & relation to Sr. examiner F1.4 Atmosphere & relation to candidates F2 Attitude
F2.1 Attitude to Sr. examiner / authorities F2.2 Attitude to candidates
F2.3 Attitude to regulations
Examples leading to a “-” :
1. Not checking if flight crew meets requirements 2. Unable to give structured (de)briefing/handle subjects.
3. Not familiar with relevant legislation articles, documents and procedures 4. Not capable of (or unfamiliar with) operating simulator.
5. Not (capable of) assessing candidate according guidelines
6. Not showing desired attitude towards candidates and/or regulations.
7. Incomplete training received or insufficient training/checking performed to (re)qualify.
Report
Examiner assessment of competence Human Environment and Transport Inspectorate Ministry of Infrastructure and Water ManagementILT.219.04 | 3 of 3
